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Declar~tior~ af DQmic~le ~s~d C:tiz~n~h~p
'1'U Ttil: STA~'i: ANU COUNTI' TAX ASSESSOR, ~g~336
ST. LUCIE _ LOUNTY, FLORIUA:
Ti~is is my declaration of Damicilc and Citizensliip in the State of rlorida that I an~ filing this day in
:,ccorJanc~, and in conformity with Section 222.17, Florida Statutcs.
p ~ ~ - and 1 ~
1 was form~rly a Icbal resicient of ~~~r~ ~sc.~~)
~ ~,~'v~~ t~~~ . However, I have changed my domicile to
resided at ~
(St~eet end Numbe~) ~
and an d have been a bona fide resident of the State of Florida si~~ce day of
~ s F '
_ , 19 ~i~ and I residc at ~ ~o ~ .
~~-y`-'' (Street and Number) ~
` St. Lucie County, Florida,
,
- (c~ty)
and this statement is to be taken as my declaraiion of citizenship, actual legal residence and domicile in the State
of Florida. • .
(Inseri here any pertinent tacts. such u sale uf property or busineu, or relinquishment of employment at forme~ ~
domicile, removal of tamily to ne~v domicile, purchase ot home, elc.) ~
ENTERIrIG CHILDREN IN SCHOOL: HOMESTEAD EXEriPTION:
If entering children in school,
please list their names:
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!~C~S ~ ~~'1 c~,r ,r ~ r2
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; f ED AlIEI ll~~ .
; ~L1~Ci~ CObM~ `
; AOCER PO~A: ~
~ C~fRit C~FCINT ~OIMT ~
PECOR~ YERIFIEO~.~.•••i•~~
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$
~ 280336
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~ I FURTHER CERTIFY that I witl register at my local addmss when the registration books reopen, and
~ comply with ali otl~er requirements of a legal resident of this State.
~ I FURTHER CE IFY that 1 have no inicntion to rcturn to my formcr domicile, and 1 intend to remain in
~ ~ ST. LUCIE _
~ C~~ ' ~c.~ - - - , ('ottnty,
~ I~lorida, pcrn~ancntly. t~'"~~'
_
_ ~G e F/~~~~
-
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, ~ ~ 0l~ = S IGI~A RE
~
'3 .`'4' ~:I~!:~rs r IF. ~ `
: Sw¢~ii"to an ~er~~be~d ~Uefore me tl?is ~day of ^ D~ ~
_ : ~,~.`i'3~ ; ~ 74 ~D O ~la'~~-'~
A.D. 19 . i zng r ss ~
~ .pI' q~'"" CI FRI: TRCUIT t'OURT ~ , Florida
, -•,~OG'~~'. ~
_ ~ ~
~r ~ - - .
4~:~ By ~~puty Ci~:rk
- (Tu lw c~e:~ :d in dupGr.~=c anJ ~ni~inrJ fdrA ~vith ('IrrA Circuil Court. and ~uplicale wilh Tax Asxs:•.-
~ b~~~ 22~ F~t l?62 f
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